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Allergic fungal rhinosinusitis: detection of fungal DNA in sinus aspirate using polymerase chain reaction

Published online by Cambridge University Press:  08 December 2009

S M El-Morsy ,
Y W Khafagy ,
M M El-Naggar  and
A A Beih
S M El-Morsy*
Affiliation:
Department of Otorhinolaryngology, Faculty of Medicine, Mansoura University, Egypt
Y W Khafagy
Affiliation:
Department of Otorhinolaryngology, Faculty of Medicine, Mansoura University, Egypt
M M El-Naggar
Affiliation:
Medical Microbiology and Immunology, Faculty of Medicine, Mansoura University, Egypt
A A Beih
Affiliation:
Department of Otorhinolaryngology, Faculty of Medicine, Mansoura University, Egypt
*
Address for correspondence: Dr Shawky Mahmoud El-Morsy, Assistant Professor of Otolaryngology, Mansoura University, Faculty of Medicine Otorhinolaryngology Department, Elgomhoria street, Mansoura, PO 35516, Egypt-Dakhlia. Fax: +20502267016 E-mail: shawky_morsy2003@yahoo.com
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Abstract

Objective:

This study investigated allergic fungal rhinosinusitis cases, and aimed to compare the detection of fungi in sinus aspirate by culture and by polymerase chain reaction assay, and to relate the presence of fungi in the nasal sinuses to the type of fungal allergen causing disease.

Methods:

Sixty-eight cases of allergic fungal rhinosinusitis underwent fungal culture and polymerase chain reaction assay for universal fungal, aspergillus and bipolaris DNA. Aspergillus-specific immunoglobulin E levels were measured in sinus aspirate, and total serum immunoglobulin E levels were calculated. A control group of 10 cases was included in the study.

Results:

Of the 68 allergic fungal rhinosinusitis cases, only 42 (61.7 per cent) had positive fungal cultures; of the 10 controls, only three (30 per cent) had positive cultures. Species from the dematiaceous family were most commonly grown, being isolated in 30 cases (71.4 per cent). Bipolaris was the most commonly isolated species (18 cases) followed by curvularia (11 cases) and alternaria (one case). Polymerase chain reaction assay detected fungal DNA in all the allergic fungal rhinosinusitis cases and also in four controls (40 per cent). Ten patients (of 68; 14.7 per cent) were positive for Aspergillus fumigatus specific immunoglobulin E. The mean concentration of this immunoglobulin was 11.32 ± 4.12 IU/ml in patients and 0 IU/ml in controls, a statistically significant difference.

Conclusion:

Detection of fungal DNA in nasal aspirate by polymerase chain reaction was superior to fungal cultures as a method of detecting fungal growth. In allergic fungal rhinosinusitis, fungal growth is not always accompanied by an allergic reaction.

Keywords

FungusSinusitisAllergyPolymerase Chain Reaction
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 124 , Issue 2 , February 2010 , pp. 152 - 160
Copyright
Copyright © JLO (1984) Limited 2009

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Footnotes

Presented at the Rhinology World 2009 conference, 15–19 April 2009, Philadelphia, Pennsylvania, USA.

References

1Schubert, MS. Allergic fungal sinusitis: pathophysiology, diagnosis and management. Med Mycology 2009;28:1–7Google Scholar
2Millar, JW, Johnston, A, Lamb, D. Allergic aspergillosis of the maxillary sinuses. Thorax 1981;36:710–20Google Scholar
3Katzenstein, AA, Sale, SR, Greenberger, PA. Allergic aspergillus sinusitis. A newly recognized form of sinusitis. J Allergy Clin Immunol 1983;72:89–93Google Scholar
4Ence, BK, Gourley, DS, Jorgenson, NL. Allergic fungal sinusitis. Am J Rhin 1990;4:169–73Google Scholar
5Bent, JP, Kuhn, FA. Diagnosis of allergic fungal sinusitis. Otolaryngol Head Neck Surg 1994;111:580–8Google Scholar
6Huchton, DM. Allergic fungal sinusitis: an otorhinolaryngologic perspective. Allergy Asthma Proc 2003;24:307–11Google ScholarPubMed
7Ramadan, HH, Quraishi, HA. Allergic mucin sinusitis without fungus. Am J Rhinol 1997;11:145–7CrossRefGoogle ScholarPubMed
8McClay, JE, Marple, B, Kapadia, L, Biavati, MJ, Nussenbaum, B, Newcomer, M et al. Clinical presentation of allergic fungal sinusitis in children. Laryngoscope 2002;112:565–9Google Scholar
9Manning, SC, Holman, M. Further evidence for allergic fungal sinusitis. Laryngoscope 1998;108:1485–95CrossRefGoogle ScholarPubMed
10Adam, RD, Paquin, ML, Petersen, EA, Saubolle, MA, Rinaldi, MG, Corcoran, JG et al. Phaeohyphomycosis caused by the fungal genera Bipolaris and Exserohilum. A report of 9 cases and review of the literature. Medicine (Baltimore) 1986;65:203–6CrossRefGoogle ScholarPubMed
11Richardson, MD, Kokki, MH. New perspectives in the diagnosis of systemic fungal infection. Ann Med 1999;31:327–35CrossRefGoogle Scholar
12Duthie, R, Denning, DW. Aspergillus fungemia: report of two cases and review. Clin Infect Dis 1995;20:598–605CrossRefGoogle Scholar
13Vincent, JL, Anaissie, E, Bruining, H, Demajo, W, El-Ebiary, M, Haber, J et al. Epidemiology, diagnosis and treatment of systemic Candida infection in surgical patients under intensive care. Intensive Care Med 1998;24:206–16Google Scholar
14Kuhn, FA, Swain, RJ. Allergic fungal sinusitis: diagnosis and treatment. Curr Opin Otolaryngol Head Neck Surg 2003;11:1–5CrossRefGoogle ScholarPubMed
15Catten, MD, Murr, AH, Goldstein, JA, Mhatre, AN, Lalwani, AK. Detection of fungi in the nasal mucosa using polymerase chain reaction. Laryngoscope 2001;111:399–403Google Scholar
16Allphin, AL, Strauss, M, Abdul-Karim, FW. Allergic fungal sinusitis: problems in diagnosis and treatment. Laryngoscope 1991;101:815–20CrossRefGoogle ScholarPubMed
17Matsuwaki, Y, Yanagi, K, Nakajima, T, Moriyama, H. Allergic fungal sinusitis. Nippon Jibiinkoka Gakkai Kaiho 2002;105:1157–65CrossRefGoogle ScholarPubMed
18Ponikau, CS, Sherris, DA, Kern, EB, Homburger, HA, Frigas, E, Gaffey, TA et al. The diagnosis and incidence of allergic fungal sinusitis. Mayo Clin Proc 1999;74:877–84CrossRefGoogle ScholarPubMed
19Cody, DT, Neel, HB, Ferreiro, JA, Roberts, GD. Allergic fungal sinusitis: the Mayo Clinic experience. Laryngoscope 1994;104:1074–9Google Scholar
20Zieske, LA, Kopke, RD, Hamill, R. Dematiacious fungal sinusitis. Otolaryngol Head Neck Surg 1991;105:567–77Google Scholar
21Manning, SC, Scaefer, SD, Close, LG, Vuitch, F. Culture positive allergic fungal sinusitis. Arch Otolaryngol Head Neck Surg 1991;117:174–8CrossRefGoogle ScholarPubMed
22Braun, H, Stammberger, H, Buzina, W, Freudenschuss, K, Lackner, A, Beham, A. Incidence and detection of fungi and eosinophilic granulocytes in chronic rhinosinusitis [in German]. Laryngorhinootologie 2003;82:330–40Google ScholarPubMed
23Castelnuovo, P, Gera, R, Di Giulio, G, Canevari, FR, Benazzo, M, Emanuelli, E et al. Paranasal sinus mycoses. Acta Otorhinolaryngol Ital 2000;20:6–15Google ScholarPubMed
24Schubert, MS. Fungal rhinosinusitis: diagnosis and therapy. Curr Allergy Asthma Rep 2001;1:268–76Google Scholar
25Kuhn, FA, Javer, AR. Allergic fungal sinusitis: a four year follow-up. Am J Rhinology 2000;14:149–56Google Scholar
26Chang, YT, Fang, SY. Tissue specific IgE in maxillary sinus mucosa of allergic fungal sinusitis. Rhinology 2008;46:226–30Google ScholarPubMed
27Tang, P, Mohan, S, Sigler, L, Witterick, L, Summerbell, R, Campbell, I. Allergic fungal sinusitis associated with Trichoderma longibrachiatum. J Clin Microbiol 2003;41:5333–7CrossRefGoogle ScholarPubMed
28Collins, MM, Nair, SB, Wormald, PJ. Prevalence of noninvasive fungal sinusitis in South Australia. Am J Rhinology 2003;17:127–32CrossRefGoogle ScholarPubMed
29Pant, H, Kette, FE, Smith, WB, Wormald, PJ, Macardle, PJ. Fungal-specific humoral response in eosinophilic mucous chronic rhinosinusitis. Laryngoscope 2005;115:601–6CrossRefGoogle ScholarPubMed
30McCann, WA, Cromie, M, Chandler, F, Ford, J, Dolen, WK. Sensitization to recombinant Aspergillus fumigatus allergens in allergic fungal sinusitis. Ann Allergy Asthma Immunol 2002;89:203–8CrossRefGoogle ScholarPubMed
31Corradini, C, Del Ninno, M, Schiavino, D, Patriarca, G, Paludetti, G. Allergic fungal sinusitis. A naso-sinusal specific hyperreactivity for an infectious disease. Acta Otorhinolaryngol Ital 2003;23:168–74Google ScholarPubMed
32Shatkin, JS, Delsupehe, KG, Thisted, RA, Corey, JP. Mucosal allergy in the absence of systemic allergy in nasal polyposis and rhinitis: a meta-analysis. Otolaryngol Head Neck Surg 1994;111:553–6Google Scholar
33Buzina, W, Braun, H, Schimpl, K, Stammberger, H. Bipolaris spicifera causes fungus balls of the sinuses and triggers polypoid chronic rhinosinusitis in an immunocompetent patient. J Clin Microbiol 2003;41:4885–7Google Scholar
34Courley, DS, Whisman, BA, Martin, ME. Clinical and immunological characteristics of allergic fungal sinusitis caused by Bipolaris spicifera. J Allergy Clin Immunol 1998;81:285–9Google Scholar
35Willinger, B, Obradovic, A, Selitsch, B, Beck-Mannagetta, J, Buzina, W, Braun, H et al. Detection and identification of fungi from fungus balls of the maxillary sinus by molecular techniques. J Clin Microbiol 2003;41:581–5Google Scholar
36Hendolin, PH, Paulin, L, Koukila-Kahkola, P, Anttila, V, Malmberg, A, Richardson, HM et al. Panfungal PCR and multiplex liquid hybridization for detection of fungi in tissue specimens. J Clin Microbiol 2000;38:4186–92CrossRefGoogle ScholarPubMed
37Kim, ST, Choi, JH, Cha, HE, Hwang, YG, Chung, YS. Comparison between polymerase chain reaction and fungal culture for the detection of fungi in patients with chronic sinusitis and normal controls. Acta Otolaryngol 2005;125:72–5Google Scholar